Any provider who has attempted the credentialing process knows it is exactly that, a process. Applications are tedious and the follow up with insurances can take countless hours out of your day. One of the most important parts of credentialing is knowing how long the process takes so providers can plan accordingly.
Each insurance company has their own credentialing department and each department has their own process for adding a provider or group to their network. For many insurance companies the process includes:
1. Submitting the request to join the network.
2. Submitting the application for credentialing.
3. Receiving and signing a provider agreement.
Once a contract is received by the insurance company, the group or providers information is loaded into their system. The credentialing process relies heavily on accurate information and even then, problems can still arise that require immediate attention.
Now that you know the steps, it is important to know the timeline for these processes. As stated before, each insurance company is different so the timeline may also be different. The timeline for each stage is as followed:
1. Submit request to join the network-
A. Research how the insurance company receives requests to join the network. This could be a form on their website, a faxed letter of intent, or a phone call to the provider recruitment department.
B. Once a provider has submitted a request to join the network, you should expect to receive an application within 30-45 days.
2. Submit the application for credentialing-
A. Credentialing applications are long and often involve repeating the same information in multiple areas.
B. Once the credentialing application has been submitted it could take between 45-90 days for the application to be processed by the insurance’s Credentialing Committee. These committees may only meet once a month or every 3 months.
3. Receive and sign provider agreement-
A. Some insurances will send you the agreement at the same time as the application, but most send you the agreement once they have verified the information provided on the credentialing application is correct.
B. Once you return the signed contract, it could take between 30-60 days for the insurance to load the contract into their system.
While we can’t stress enough that each insurance’s credentialing process is different, we have provided a time frame so you can be as prepared when you begin the credentialing process. From beginning to end, the credentialing process could take anywhere from 90-180 days, so be sure to keep this information in mind when you are hiring a new staff member or opening your own practice.
Now that you know what your expectations are for becoming an in-network provider, you can stay ahead of the problems and save yourself a lot of frustration down the line. While many therapists know what credentialing is, many underestimate the time and energy it takes to become a participating provider. If you or your staff have questions about credentialing, give us a call at 508-422-0233 or email us at info@accountmattersma.com.
